1/164. actinomycosis of the central nervous system: surgical treatment of three cases.Three cases of actinomycotic brain infection are described, 2 of which manifested as cerebral abscess, the third as epidural empyema. Complete resolution of the infection was always achieved by means of surgical treatment and prolonged antibiotic therapy. The cases reported emphasize the importance of a combined approach in the treatment of this unusual cause of brain infection.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
2/164. role of diffusion-weighted echo-planar MRI in distinguishing between brain brain abscess and tumour: a preliminary report.Our purpose was to evaluate diffusion-weighted (DW) echo-planar MRI in differentiating between brain abscess and tumour. We examined two patients with surgically confirmed pyogenic brain abscess and 18 with metastatic brain tumours or high-grade glioma, using a 1.5 T system. The apparent diffusion coefficient (ADC) of each necrotic or solid contrast-enhancing lesion was measured with two different b values (20 and 1200 s/mm2). All capsule-stage brain abscesses (4 lesions) and zones of cerebritis (2 lesions) were identified on high-b-value DWI as markedly high-signal areas of decreased ADC (range, 0.58-0.70 [(10-3 mm2/s; mean, 0.63)]). All cystic or necrotic portions of brain tumours (14 lesions) were identified on high-b-value DWI as low-signal areas of increased ADC (range, 2.20-3.20 [(10-3 mm2/s; mean, 2.70)]). Solid, contrast-enhancing portions of brain tumours (19 lesions) were identified on high-b-value DWI as high-signal areas of sightly decreased or increased ADC (range, 0.77-1.29 [(10-3 mm2/s; mean, 0.94)]). Our preliminary results indicate that DW echo-planar MRI be used for distinguishing between brain abscess and tumour.- - - - - - - - - - ranking = 8keywords = abscess (Clic here for more details about this article) |
3/164. Intracranial tuberculomas.In this paper the clinical findings, operation results and histological diagnosis of eight patients with intracranial tuberculomas are described, which were admitted to the Neurosurgical Clinic of Ankara University, faculty of medicine, during the years 1967-1975, among the 1,015 histologically verified intracranial tumours. Our impression by reviewing previous papers on this matter is, that although tuberculomas are not so frequently seen as before, they still count as a certain percentage in turkey.- - - - - - - - - - ranking = 52057.293220296keywords = intracranial tuberculoma, tuberculoma (Clic here for more details about this article) |
4/164. Fatal chaetomium cerebritis in a bone marrow transplant patient.The number of opportunistic infections in the central nervous system (CNS) has been steadily increasing because of a rising number of immunocompromised patients. A rare form of CNS infection can be caused by chaetomium species, one of the largest genera of saprophytic ascomycetes. The CNS lesions in the present case were caused by chaetomium atrobrunneum. The main characteristic of almost all chaetomium species is presence of hairs or setae covering the ascomata. Microbiological studies are the only definitive way to correctly identify this fungal organism. The rapid evolvement of the cerebral infection suggests that the brain tissue provides a favorable environment for growth and proliferation of these fungi. This is the second documented case of a fatal brain abscess caused by chaetomium atrobrunneum, and the first case report in a bone marrow transplant patient.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
5/164. cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (Ramichloridium mackenziei): case report.OBJECTIVE AND IMPORTANCE: Only a few cerebral infections with the dark-walled mold Ramichloridium obovoideum (Ramichloridium mackenziei) have been reported in the literature. central nervous system infections caused by this fungus have poor prognoses; the optimal medical and surgical treatments have not yet been established. We report a case of cerebral R. obovoideum infection for which a combination of medical and surgical treatments failed. CLINICAL PRESENTATION: A 58-year-old Kuwaiti woman, with a history of chronic renal failure requiring hemodialysis, presented with a 3-day history of left frontal headache, blurry vision, dizziness, and right-sided clumsiness. Computed tomography demonstrated multiple, ring-enhancing, cerebral lesions (the largest of which measured 2-3 cm) in the deep left parieto-occipital region. INTERVENTION: A computed tomography-guided needle biopsy of the parieto-occipital lesion yielded 10 ml of dark caseous fluid. Stains demonstrated long, branching, septate hyphae. Fungal cultures grew R. obovoideum. The patient was treated with a combination of amphotericin b and itraconazole. The condition of the patient continued to deteriorate, and stereotactic aspiration of the largest lesion was performed. Despite this approach, the lesion progressed and the patient died. CONCLUSION: R. obovoideum is being increasingly recognized as a cause of cerebral abscesses in patients residing in the middle east. Prognoses are poor, and responses to antifungal therapy are generally short-lived. Until more effective therapies are found, the greatest chance for adequate treatment involves early recognition, prompt treatment with antifungal agents, and attempts at complete resection.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
6/164. Endoscopic stereotactic surgery for intraventricular loculated empyema: case report.BACKGROUND: Ventriculitis accompanied by formation of an intraventricular loculated empyema is a very unusual complication of purulent meningitis. CASE DESCRIPTION: A 62-year-old man presented with acute purulent ventriculitis secondary to a small paraventricular abscess. The well-documented computed tomography scans demonstrated the development of an intraventricular loculated empyema in the posterior portion of the left lateral ventricle. A stereotactically guided endoscopic procedure was performed to drain and rinse the empyema and to remove membranous tissue in order to establish free communication with the ventricular system. In the further course, a ventriculoperitoneal shunt was placed. The patient had recovered almost completely 1 year after the procedure. CONCLUSIONS: Ventriculitis frequently results in severe morbidity and often causes death. Intraventricular pathologies can be treated effectively by endoscopic stereotactic methods. To our knowledge, this is the first case of successful treatment of an intraventricular loculated empyema in an adult.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
7/164. Intraventricular tuberculous abscess: a case report.Ventricles can be involved in different ways in neurotuberculosis, however, the occurrence of intraventricular abscess has been rarely reported. We report a young woman who had intraventricular tubercular abscess. Cranial computed tomographic scan showed hypodense ring enhancing lesion in the right lateral ventricle with unilateral hydrocephalus. She underwent parasagittal craniotomy with total excision of the lesion. The pus obtained from the lesion was teeming with acid fast bacilli.- - - - - - - - - - ranking = 6keywords = abscess (Clic here for more details about this article) |
8/164. case reports of nocardiosis in patients with human immunodeficiency virus (hiv) infection.INTRODUCTION: We present 4 local cases of nocardiosis in hiv-infected patients and discuss the diagnosis, clinical syndromes and therapy of nocardiosis. CLINICAL PICTURE: Two cases presented with pulmonary nocardiosis, one had a cervical lymph node abscess and one had disseminated nocardiosis with pulmonary, cerebral and soft tissue involvement. TREATMENT: Combination therapy is often employed. Sulphonamides or co-trimoxazole, amikacin, imipenen, minocycline and ceftriaxone are some of the drugs that could be used. OUTCOME: Outcome hinges on the early recognition and optimal treatment of this infection. CONCLUSIONS: Clinical presentations vary and diagnosis is difficult and frequently delayed. Nocardiosis should be suspected in patients who present with pulmonary lesions with soft tissue and/or cerebral abscesses.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
9/164. Intrasellar tuberculoma--an enigmatic pituitary infection: a series of 18 cases.OBJECTIVE: Intrasellar tuberculomas are rare and only few case reports have been described in the literature. We report a series of 18 cases of histologically proven intrasellar tuberculomas, which, to the best of our knowledge, is the largest series in the English literature. methods: A total of 1143 pituitary lesions, between 1984 and June 1999, were operated for various reasons in our institute. Of these, 18 cases were histopathologically proven intrasellar tuberculomas. The clinical profile was reviewed in detail. Radiological data and histopathological slides were also reviewed. RESULTS: The age ranged from 8 to 43 years (average 23.6 years) with a female preponderance. The duration of symptoms varied from 15 days to 2 years (average 4 months), the most common symptoms being headache followed by decrease or loss of vision. Five patients had features of pan-hypopituitarism whereas three had raised prolactin (PRL) levels. In six patients, both sella as well as sphenoid sinus were involved. In one patient the lesion was extending from the sella over the clivus. Clinically as well as radiologically, these lesions were mistaken for pituitary adenomas except for one case where tuberculoma was suspected on imaging. In three patients, there was past history of pulmonary tuberculosis, in one patient of tuberculous meningitis, and in one patient, of spondilytis of the spine. In one patient there was cervical lymphadenopathy along with features of acromegaly (also proved by high levels of serum growth hormone) and radiology revealed a pituitary pathology. Microscopic examination of the excised lesion revealed a composite lesion consisting of a pituitary adenoma and tuberculoma, which has not been documented in literature to date. One patient died during the hospital stay. All the other patients were put on antitubercular chemotherapy following surgery and had good outcomes. CONCLUSION: Intrasellar tuberculomas are rare. These may be suspected in female patients especially if radiological imaging shows involvement of paranasal sinuses and pituitary fossa along with thickening of pituitary stalk. Simultaneous involvement of clivus may also be an additional feature. The incidence of pituitary tuberculosis is likely to increase with a rise in the incidence of AIDS.- - - - - - - - - - ranking = 38065.046064204keywords = tuberculoma (Clic here for more details about this article) |
10/164. Paradoxical response to antitubercular drugs.Seven patients with paradoxical response to antitubercular drugs are reported. In three cases of intracranial tuberculomas, newer lesions appeared and in two cases preexisting tuberculomas enlarged. In two cases of tubercular meningitis, multiple tuberculomas appeared. All these cases exhibited newer symptoms and CT/MBI revealed the paradoxical response to antitubercular drugs. All responded to continued conservative therapy, with addition of pyrazinamide.- - - - - - - - - - ranking = 40637.779401035keywords = intracranial tuberculoma, tuberculoma (Clic here for more details about this article) |
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